Claims Examiner(Fully Remote)

Primary Purpose The Senior General Liability Claims Analyst is responsible for analyzing and managing complex or technically challenging general liability claims to determine benefits due and ensure appropriate resolution. This role handles high-exposure claims involving litigation and rehabilitation, ensures claims are adjudicated in accordance with service expectations, industry best practices, and client requirements, and identifies subrogation opportunities while negotiating settlements within assigned authority. Essential Functions & Responsibilities Claims Analysis & Resolution

• Analyze and process complex or technically difficult general liability claims by investigating facts, gathering documentation, and determining exposure.
• Develop and manage comprehensive action plans to drive timely and appropriate claim resolution.
• Assess liability and resolve claims within established evaluation parameters.
• Negotiate claim settlements within designated authority levels.

Financial Management & Compliance

• Establish, calculate, and maintain accurate claim reserves throughout the life of the claim.
• Calculate and authorize benefit payments, claim adjustments, and settlements in a timely manner.
• Prepare and submit required state filings within statutory guidelines.
• Report claims to excess carriers and respond promptly and professionally to requests for direction.

Litigation & Vendor Management

• Manage the litigation process to ensure cost-effective and timely resolution.
• Coordinate vendor referrals for investigation, medical management, and litigation support.
• Apply cost containment strategies, including the use of strategic vendor partnerships, to reduce overall claim costs.

Recoveries & Subrogation

• Identify and manage claim recoveries, including subrogation, Second Injury Fund recoveries, and Social Security and Medicare offsets.

Communication & Documentation

• Communicate claim activity and status clearly with claimants, clients, and internal stakeholders.
• Maintain accurate and complete claim documentation and ensure proper claims coding.
• Escalate cases to supervisors or management as appropriate.

Additional Responsibilities

• Support organizational quality assurance programs.
• Perform other duties as assigned.
• Travel as required.

Qualifications

Education & Licensing

• Bachelor's degree from an accredited college or university preferred
• Professional certification relevant to the line of business preferred

Experience

• Minimum of five (5) years of claims management experience or an equivalent combination of education and experience

Skills & Knowledge

• Subject matter expertise in applicable insurance principles, laws, and regulations for the assigned line of business
• Knowledge of recoveries, offsets, deductions, disability duration, and cost containment practices
• Understanding of medical management, Social Security, and Medicare application procedures
• Strong analytical and interpretive skills
• Excellent oral and written communication, including presentation skills
• Advanced negotiation skills
• Strong organizational and time-management abilities
• Proficiency with Microsoft Office and general PC applications
• Ability to work effectively in a team environment
• Ability to meet or exceed established service expectations

Work Environment

Mental Requirements

• Strong analytical thinking, judgment, and problem-solving skills
• Ability to manage multiple priorities, meet deadlines, and handle work-related stress
• High level of discretion and decision-making capability

Physical Requirements

• Prolonged computer keyboarding
• Travel as required

Sensory Requirements

• Ability to hear, speak, and see clearly to perform job duties

Additional Requirements

• Credit security clearance, confirmed through a background credit check, is required for this position.

Nesco Resource offers a comprehensive benefits package for our associates, which includes a MEC (Minimum Essential Coverage) plan that encompasses Medical, Vision, Dental, 401K, and EAP (Employee Assistance Program) services. Nesco Resource provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws. Apply tot his job Apply To this Job